Epidemiological Features of Spinal Cord Injury in China: A Systematic Review

Global incidence and characteristics of spinal cord injury since 2000-2021: a systematic review and meta-analysis

BACKGROUND

This study employs systematic review and meta-analysis to explore the incidence and characteristics of spinal cord injury (SCI) between 2000 and 2021, aiming to provide the most recent and comprehensive data support for the prevention, diagnosis, treatment, and care of SCI.

METHODS

Systematic searches were conducted on epidemiological studies of SCI published between January 1, 2000, and March 29, 2024. Meta-analysis, subgroup analysis, meta-regression, publication bias detection, and literature quality assessment were extensively utilized.

RESULTS

The pooled results from 229 studies indicated that the overall incidence rate of SCI was 23.77 (95% CI, 21.50-26.15) per million people, with traumatic spinal cord injuries (TSCI) at a rate of 26.48 (95% CI, 24.15-28.93) per million people, and non-traumatic spinal cord injuries (NTSCI) at a rate of 17.93 (95% CI, 13.30-23.26) per million people. The incidence of TSCI exhibited a marked age-related increase and was significantly higher in community settings compared to hospital and database sources. Males experienced TSCI at a rate 3.2 times higher than females. Between 2000 and 2021, the incidence of TSCI remained consistently high, between 20 and 45 per million people, whereas NTSCI incidence has seen a steady rise since 2007, stabilizing at a high rate of 25-35 per million people. Additionally, the incidence of TSCI in developing countries was notably higher than that in developed countries. There were significant differences in the causes of injury, severity, injury segments, gender, and age distribution among the TSCI and NTSCI populations, but the proportion of male patients was much higher than that of female patients. Moreover, study quality, country type, and SCI type contributed to the heterogeneity in the meta-analysis.

CONCLUSIONS

The incidence rates of different types of SCI remain high, and the demographic distribution of SCI patients is changing, indicating a serious disease burden on healthcare systems and affected populations. These findings underscore the necessity of adopting targeted preventive, therapeutic, and rehabilitative measures based on the incidence and characteristics of SCI.

Analysis and experimental validation of genes and their transcription factor prediction in contused rat spinal cord at the intermediate phase

The intermediate phase of spinal cord injury (SCI) serves as an important target site for therapeutic mediation of SCI. However, there is a lack of insight into the mechanism of the intermediate phase of SCI. The present study aimed to investigate the molecular mechanism and the feasible treatment targets in the intermediate phase of SCI. We downloaded GSE2599 from GEO and identified 416 significant differentially expressed genes (DEGs), including 206 downregulated and 210 upregulated DEGs. Further enrichment analysis of DEGs revealed that many important biological processes and signal pathways were triggered in the injured spinal cord. Furthermore, a protein-protein interaction (PPI) network was constructed and the top 10 high-degree hub nodes were identified. Furthermore, 27 predicted transcription factors (TFs) and 136 predicted motifs were identified. We then selected insulin-like growth factor 1 (IGF1) and its predicted transcription factor, transcription factor A, mitochondrial (TFAM) for further investigation. We speculated and preliminarily confirmed that TFAM may regulate gene transcription of IGF1 and effected alterations in the function recovery of rats after SCI. These findings together provide novel information that may improve our understanding of the pathophysiological processes during the intermediate phase of SCI.

Applications of Stem Cell-Derived Extracellular Vesicles in Nerve Regeneration

Extracellular vesicles (EVs), including exosomes, microvesicles, and other lipid vesicles derived from cells, play a pivotal role in intercellular communication by transferring information between cells. EVs secreted by progenitor and stem cells have been associated with the therapeutic effects observed in cell-based therapies, and they also contribute to tissue regeneration following injury, such as in orthopaedic surgery cases. This review explores the involvement of EVs in nerve regeneration, their potential as drug carriers, and their significance in stem cell research and cell-free therapies. It underscores the importance of bioengineers comprehending and manipulating EV activity to optimize the efficacy of tissue engineering and regenerative therapies.

Epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China: a hospital-based retrospective study

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death. China has the largest population of patients with traumatic spinal cord injury. Previous studies of traumatic spinal cord injury in China have mostly been regional in scope; national-level studies have been rare. To the best of our knowledge, no national-level study of treatment status and economic burden has been performed. This retrospective study aimed to examine the epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China at the national level. We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China. Patient epidemiological and clinical features, treatment status, and total and daily costs were recorded. Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program. The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall (annual percentage change, -0.5% and 2.1%, respectively). A total of 10,053 (74.7%) patients underwent surgery. Only 2.8% of patients who underwent surgery did so within 24 hours of injury. A total of 2005 (14.9%) patients were treated with high-dose (≥ 500 mg) methylprednisolone sodium succinate/methylprednisolone (MPSS/MP); 615 (4.6%) received it within 8 hours. The total cost for acute traumatic spinal cord injury decreased over the study period (-4.7%), while daily cost did not significantly change (1.0% increase). Our findings indicate that public health initiatives should aim at improving hospitals' ability to complete early surgery within 24 hours, which is associated with improved sensorimotor recovery, increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

Efficacy of growth factor gene-modified stem cells for motor function after spinal cord injury in rodents: a systematic review and meta‑analysis

The efficacy of growth factor gene-modified stem cells in treating spinal cord injury (SCI) remains unclear. This study aims to evaluate the effectiveness of growth factor gene-modified stem cells in restoring motor function after SCI. Two reviewers searched four databases, including PubMed, Embase, Web of Science, and Scopus, to identify relevant records. Studies on rodents assessing the efficacy of transplanting growth factor gene-modified stem cells in restoring motor function after SCI were included. The results were reported using the standardized mean difference (SMD) with a 95% confidence interval (95% CI). Analyses showed that growth factor gene-modified stem cell transplantation improved motor function recovery in rodents with SCI compared to the untreated (SMD = 3.98, 95% CI 3.26-4.70, I2 = 86.8%, P < 0.0001) and stem cell (SMD = 2.53, 95% CI 1.93-3.13, I2 = 86.9%, P < 0.0001) groups. Using growth factor gene-modified neural stem/histone cells enhanced treatment efficacy. In addition, the effectiveness increased when viral vectors were employed for gene modification and high transplantation doses were administered during the subacute phase. Stem cells derived from the human umbilical cord exhibited an advantage in motor function recovery. However, the transplantation of growth factor gene-modified stem cells did not significantly improve motor function in male rodents (P = 0.136). Transplantation of growth factor gene-modified stem cells improved motor function in rodents after SCI, but claims of enhanced efficacy should be approached with caution. The safety of gene modification remains a significant concern, requiring additional efforts to enhance its clinical translatability.

Epidemiology features of traumatic and non-traumatic spinal cord injury in China, Wuhan

Spinal cord injuries are incredibly disabling and can have fatal consequences. At present, there is a lack of available information regarding the epidemiological characteristics of patients who have experienced spinal cord injury (SCI) in China. This retrospective hospital-based study was conducted in the Rehabilitation department of Wuhan's Tongji Hospital between 2016 and 2022. A total of 649 individuals diagnosed with SCI (both traumatic and non-traumatic) were admitted during this period. Data regarding various epidemiological features were gathered, including sex, age, etiology, occupation, neurological level of injury, the American Spinal Injury Association Impairment Scale at the time of admission, and information on any accompanying injuries. Out of the 649 cases of SCI, there were 539 cases of traumatic SCI and 110 cases of non-traumatic SCI. The mean age at the time of injury was 45.6 ± 14.8 years. The ratio of male to female patients was higher in traumatic SCI at 2.82:1compared to non-traumatic SCI at 1.68:1. Traffic accidents were the most common cause of TSCI, accounting for (n = 207/539; 38.40%) of cases. On the other hand, neoplasm was the most common cause of NTSCI, accounting for (n = 38/110; 34.54%) of cases. The findings indicated a higher proportion of males, with traffic accidents being the main cause of injury among TSCI patients. It is crucial to prioritize the risk of falling among older adults and allocate more attention to this issue. These results emphasize the need for tailored preventive strategies that consider the unique characteristics of different types of SCI patients.

The Comparative Effects of Schwann Cells and Wharton's Jelly Mesenchymal Stem Cells on the AIM2 Inflammasome Activity in an Experimental Model of Spinal Cord Injury

Inflammasome activation and the consequent release of pro-inflammatory cytokines play a crucial role in the development of sensory/motor deficits following spinal cord injury (SCI). Immunomodulatory activities are exhibited by Schwann cells (SCs) and Wharton's jelly mesenchymal stem cells (WJ-MSCs). In this study, we aimed to compare the effectiveness of these two cell sources in modulating the absent in melanoma 2 (AIM2) inflammasome complex in rats with SCI. The Basso, Beattie, Bresnahan (BBB) test, Nissl staining, and Luxol fast blue (LFB) staining were performed to evaluate locomotor function, neuronal survival, and myelination, respectively. Real-time polymerase chain reaction (RT-PCR), Western blotting, and enzyme-linked immunosorbent assay (ELISA) were employed to analyze the gene and protein expressions of inflammasome components, including AIM2, ASC, caspase-1, interleukin-1β (IL-1β), and IL-18. Both gene and protein expressions of all evaluated factors were decreased after SC or WJ-MSC treatment, with a more pronounced effect observed in the SCs group (P < 0.05). Additionally, SCs promoted neuronal survival and myelination. Moreover, the administration of 3 × 105 cells resulted in motor recovery improvement in both treatment groups (P < 0.05). Although not statistically significant, these effects were more prominent in the SC-treated animals. In conclusion, SC therapy demonstrated greater efficacy in targeting AIM2 inflammasome activation and the associated inflammatory pathway in SCI experiments compared to WJ-MSCs.

Decellularized extracellular matrix in the treatment of spinal cord injury

Functional limitation caused by spinal cord injury (SCI) has the problem of significant clinical and economic burden. Damaged spinal axonal connections and an inhibitory environment severely hamper neuronal function. Regenerative biomaterials can fill the cavity and produce an optimal microenvironment at the site of SCI, inhibiting apoptosis, inflammation, and glial scar formation while promoting neurogenesis, axonal development, and angiogenesis. Decellularization aims to eliminate cells from the ultrastructure of tissues while keeping tissue-specific components that are similar to the structure of real tissues, making decellularized extracellular matrix (dECM) a suitable scaffold for tissue engineering. dECM has good biocompatibility, it can be widely obtained from natural organs of different species, and can be co-cultured with cells for 3D printing to obtain the target scaffold. In this paper, we reviewed the pathophysiology of SCI, the characteristics of dECM and its preparation method, and the application of dECM in the treatment of SCI. Although dECM has shown its therapeutic effect at present, there are still many indicators that need to be taken into account, such as the difficulty in obtaining materials and standardized production mode for large-scale use, the effect of decellularization on the physical and chemical properties of dECM, and the study on the synergistic effect of dECM and cells.

Sex-related Differences in Epidemiology, Treatment, and Economic Burden of Traumatic Spinal Cord Injury in China (2013-2018)

STUDY DESIGN

Retrospective epidemiological study.

OBJECTIVE

To describe differences based on biological sex in the epidemiology and treatment of the economic burden of traumatic spinal cord injury (TSCI) in China (2013-2018).

SUMMARY OF BACKGROUND DATA

Although there have been many regional single-center studies on TSCI in China, there are few reports involving multicenter data, especially those that report on discrepancies related to biological sex.

MATERIALS AND METHODS

This study is a nationally representative hospital-based retrospective study. The treatment data of TSCI patients in 30 hospitals in 11 provinces/cities from January 2013 to December 2018 were analyzed. Sociodemographic characteristics, accident and related injury characteristics, treatment methods, and hospital costs were obtained. Regression models were used to evaluate differences in the outcomes of interest based on biological sex and other factors.

RESULTS

There were 13,465 individuals with TSCI, with a mean age of 50.0 years, and females (52.2) older than males (49.3). Overall, the average ratio of males to females was 3.1:1, ranging from 3.0:1 in 2013 to 2.8:1 in 2018. The overall proportion of patients with TSCI increased from 2013 to 2018 [annual percentage change (APC)=6.8%, 95% CI, 3.3-10.4] ( P < 0.05). The percent increase in females (APC=8.2%, 95% CI, 5.6-10.8) was greater than that of males (APC=6.3%, 95% CI, 2.1-10.6). Overall, high-level falls mainly affected males (30.8%), and low-level falls mainly occurred in females (36.6%). Females demonstrated a higher frequency of thoracolumbar trauma and less severe neurological impairment.

CONCLUSIONS

This study suggests that although the main population of TSCI is male, the average ratio of males to females is decreasing. The frequency of TSCI may be increasing faster in females than in males. Therefore, it is necessary to develop sex-specific public prevention measures. In addition, more medical resources should be devoted to improving the ability of hospitals to perform early surgery.

Predictors of hospital-acquired pressure injuries in patients with complete spinal cord injury: a retrospective case-control study

BACKGROUND

Despite current best practices, pressure injuries (PI) remain a devastating and prevalent hospital-acquired complication for patients with acute traumatic spinal cord injuries (SCIs). This study examined associations between risk factors for PI development in patients with complete SCI, such as norepinephrine dose and duration, and other demographic factors or lesion characteristics.

METHODS

This case-control study included adults with acute complete SCIs ASIA-A, who were admitted to a level-one trauma center between 2014-18. A retrospective review was implement using data on patient and injury characteristics, including age, gender, level of SCI (cervical vs. thoracic), Injury Severity Score (ISS), length of stay (LOS) and mortality; presence/absence of PI during their acute hospital stay; and treatment factors such as spinal surgery, mean arterial pressure (MAP) targets, and vasopressor treatment. Multivariable logistic regression evaluated associations with PI.

RESULTS

Eighty-two out of 103 eligible patients had complete data, and 30 (37%) developed PIs. Patient and injury characteristics, including age (Mean: 50.6; SD:21.3), location of SCI (48 cervical, 59%) and ISS (Mean 33.1; SD:11.8), did not differ between PI and non-PI groups. Logistic regression analysis revealed that male gender (OR:34.1; CI₉₅:2.3-506.5, p = 0.010) and increased LOS (log-transformed; OR:20.5, CI₉₅:2.8-149.9, p = 0.003) were associated with increased risk of PI. Having an order for a MAP > 80mmg (OR:0.05; CI₉₅:0.01-0.30, p = 0.001) was associated with a reduced risk of PI. There were no significant associations between PI and duration of norepinephrine treatment.

CONCLUSIONS

Norepinephrine treatment parameters were not associated with development of PI, suggesting that MAP targets should be a focus for future investigations for SCI management. Increasing LOS should highlight the need for high-risk PI prevention and vigilance.

Incidence of spinal cord injuries in Constanta County (Romania) between 2017-2021

Background: The purpose of this study was to investigated cases of spinal cord injury (SCI) during the years 2017-2021, in Constanta County (Romania) to update the data on SCI and thus identify the SCI trends in this region of Romania. Methods: The study retrospectively analysed patients with SCI in Constanța County, whose data (medical records) were provided to us by the Romania Motivation Foundation. This analysis was made for the period January 1, 2017 - August 31, 2021. Results: Ninety-six new traumatic cases of SCI were reported between 2017 and 2021 in Constanța County. It was found that the annual incidence is 2.48 per hundred thousand inhabitants. The male / female ratio was 5:1 and the mean age at injury was 33.52 ± 15.1 (33.41 ± 14.80 for men and 33.92 ± 16.01 for women). The most common cause of injury was unintentional fall (48.95%), followed by road accidents (39.58%), stab wounds (4.16%), gunshot wounds (3.12%) and injuries caused by diving 2.08%). Fifteen patients (15.62%) were quadriplegic, and 81 patients (84.37%) were paraplegic. The most common level of lesions was C4 (33.33%) in tetraplegics and T12 (25.92%) in paraplegics. The most common associated injury was head trauma (15.8%), followed by limb fractures (9.5%). The incidence rate of SCI in Constanta County increased (p <0.05) and the highest increase in the incidence of spinal cord injuries was observed among patients in the age groups 29 - 49 years. Conclusions: Due to the existence of limitations, it is difficult to obtain accurate epidemiological data for SCI. Therefore, more studies are needed to provide a large amount of data and evidence. Our data indicate the need to take measures both for prevention and to provide specialized care for this type of traumatic pathology.

The trends in sports-related spinal cord injury in China

STUDY DESIGN

Retrospective epidemiological study.

OBJECTIVES

To determine the characteristics of sports-related spinal cord injury (SCI) in China and assess changes in the trend of these injuries that may impact policy making.

SETTING

China Rehabilitation Research Center (CRRC), Beijing.

METHODS

Of the 2448 SCI cases reviewed, 6.7% (n = 164) were caused by sport- and recreation-related accidents. They were admitted to the CRRC between January 1, 2013 and December 31, 2019. We collected data on age, sex, etiology, the neurological level of injury, the American Spinal Injury Association (ASIA) Impairment Scale (AIS) scores on admission, and the neurological recovery results at discharge.

RESULTS

Dancing (58.6%), followed by water sports (14.7%) and taekwondo (4.2%) were the leading etiologies. Of the SCIs caused by dancing, 27.1% of the individuals had incomplete injury, and of these, 57.7% showed improved neurological function. However, 72.9% had complete injury, and these individuals did not show any improvement in neurological function. Individuals with dance-related SCIs graded as A and D according to the AIS, showed no significant improvement in their motor function scores at the time of discharge. While the scores of those graded B and C increased significantly, there were no significant differences in the light touch and pin touch scores.

CONCLUSIONS

The etiology of sports-related SCI in China has changed dramatically, with dancing replacing water sports as the primary cause of SCIs. Individuals with dance-related SCIs have a poor prognosis. In China, prevention of dance-related SCIs has become a priority.

Incidence, prevalence and disability of spinal cord injury in China from 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019

PURPOSE

We aimed to estimate the incidence, prevalence and years lived with disability (YLDs) of spinal cord injury (SCI) in China in 2019 and temporal trends from 1990 to 2019.

METHODS

The Global Burden of Disease Study 2019 was used to obtain data. Outcome measures included age-standardized incidence rate (ASIR), prevalence rate (ASPR) and YLDs rate (ASYR). A Bayesian meta-regression tool, DisMod-MR 2.1, was used to produce the estimates of each value after adjustments.

RESULTS

In 2019, there were 234.19 [95% uncertainty interval (UI) 171.84-312.87] thousand incident cases of SCI in China, with an ASIR of 13.87 (95% UI 10.15-18.66) per 100,000. ASIR and ASYR increased by 40.81% (95% UI 32.92-49.14%) and 11.44% (95% UI 5.16-17.29%) compared with 1990, individually. Males had higher ASIR and ASYR in each year from 1990 to 2019, but the incidence and YLDs rates of females exceeded males after 70 years old. Incidence and YLDs rates both ascended with age. SCI at neck level had slightly higher incidence rate but much higher YLDs rate than that below neck level. The average incidence age increased from 38.97 in 1990 to 54.59 in 2019. Falls were the leading cause of SCI.

CONCLUSION

The incidence and burden of SCI in China increased significantly during the past three decades. The age structure of SCI patients showed a shift from the young to the elderly as population aging. Urgent efforts are needed to relieve the health pressure from SCI.

Incidence and pattern of traumatic spine injury in a single level I trauma center of southern Iran

PURPOSE

Spine injury is one of the leading causes of death and mortality worldwide. The objective of this study was to determine the incidence, pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last three years.

METHODS

This is a cross-sectional study conducted between 2018 and 2021 in the largest trauma center in the southern Iran. The data collection form included the age, sex, injury location (cervical, thoracic, and lumbar), canuse of injury (traffic accidents, falls, and assaults), length of hospital stay, injured segment of spine injury, severity of injury, and outcome. Statistical analyzes were performed using SPSS software version 24.

RESULTS

Totally 776 cases of spine injury were identified. The spine injury rate was 17.0%, and the mortality rate was 15.5%. Cervical spine injury (20.4%) more often occulted in motorcycle accident, and thoracic spine injury (20.1%) occulted in falls. The highest and lowest rates of spine injurys were related to lumbar spine injury (30.2%) and cervical spine injury (21.5%), respectively. There was a statistically significant relationship between the mechanism of injury and the location of spine injury (p ≤ 0.001). And patients with lumbar spine injury had the highest mortality rate (16.7%). Injury severity score (OR= 1.041, p ≤ 0.001) and length of stay (OR = 1.018, p ≤ 0.001) were strong predictors of mortality in trauma patients with spine injury.

CONCLUSION

The results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0% in southern of Iran. Road traffic injury and falls are the common mechanism of injury to spine. It is important to improve the safety of roads, passages, and work environment, and increase the quality of cars. Also, paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of SCI in multiple trauma patients.

A critical appraisal of clinical practice guidelines for management of four common complications after spinal cord injury

BACKGROUND CONTEXT

Complications such as pressure sores, pulmonary infection, urinary tract infection (UTI), and venous thromboembolism (VTE) are common after spinal cord injury (SCI). These have serious consequences for patients' physical, social, and vocational well-being. Several authoritative organizations have developed guidelines for managing these complications after SCI.

PURPOSE

We aim to systematically review and appraise guidelines on the management of four common complications (pressure sores, pulmonary infection, UTI, and VTE) after SCI as well as to summarize relevant recommendations and assess the quality of their supporting evidence.

DESIGN

Systematic review.

METHODS

We searched Medline, Embase, Cochrane, and Web of Science, as well as guideline-specific databases (e.g., National Guideline Clearinghouse) and Google Scholar, from January 2000 to January 2022. We included the most updated guidelines developed by specific authoritative organizations. We evaluated the included guidelines using the Appraisal of Guidelines for Research and Evaluation 2nd edition instrument, which measures six domains (e.g., applicability). Recommendations extracted from guidelines were categorized as for, against, or neither for nor against. An evidence assessment was adopted to classify the quality of supporting evidence as poor, fair, or good.

RESULTS

Eleven guidelines from 2005 to 2020 were included, all of which, among the six domains, scored lowest in the domain of applicability. For pressure sores, guidelines recommended for skin inspection, repositioning, and the use of pressure reduction equipment as preventive measures and dressings, debridement, and surgery as treatment measures. For pulmonary infection, guidelines recommended for physical (e.g., the use of an insufflation-exsufflation device) and pharmacological measures (e.g., the use of bronchodilators). For UTI, guidelines recommended for antibiotics as a treatment measure but recommended against cranberries, methenamine salts, and acidification or alkalinization agents as preventive measures. For VTE prophylaxis, five guidelines recommended for low molecular weight heparin (LMWH). Three guidelines recommended against unfractionated heparin, whereas one guideline recommended for it. Most of the supporting evidence was of poor quality (130/139), and the rest was of fair quality (9/139).

CONCLUSIONS

For pressure sores, pulmonary infection, and UTI, evidence of poor to fair quality indicated consistent recommendations for prevention and treatment measures. For VTE, LMWH was consistently recommended, whereas recommendations on the use of unfractionated heparin were controversial.

Quercetin Derivatives in Combating Spinal Cord Injury: A Mechanistic and Systematic Review

Spinal cord injury (SCI) possesses a complicated etiology. There is no FDA-approved treatment for SCI, and the majority of current interventions focus on reducing symptoms. During SCI, inflammation, oxidative stress, apoptosis, and autophagy are behind the secondary phase of SCI and cause serious consequences. It urges the need for providing multi-targeting agents, that possess lower side effects and higher efficacy. The plant secondary metabolites are multi-targeting agents and seem to provide new roads in combating diseases. Flavonoids are phytochemicals of continual interest to scientists in combating neurodegenerative diseases (NDDs). Flavonoids are being studied for their biological and pharmacological effects, particularly as antioxidants, anti-inflammatory agents, anti-apoptotic, and autophagy regulators. Quercetin is one of the most well-known flavonols known for its preventative and therapeutic properties. It is a naturally occurring bioactive flavonoid that has recently received a lot of attention for its beneficial effects on NDDs. Several preclinical evidence demonstrated its neuroprotective effects. In this systematic review, we aimed at providing the biological activities of quercetin and related derivatives against SCI. Detailed neuroprotective mechanisms of quercetin derivatives are also highlighted in combating SCI.

Effects of melatonin-pretreated adipose-derived mesenchymal stem cells (MSC) in an animal model of spinal cord injury

Background

One of the most serious nervous system diseases is spinal cord injury(SCI), which is increasing for various reasons. Although no definitive treatment has yet been identified for SCI, one possible treatment is adipose-derived stem cells(ADSCs). However, a key issue in transplantation is improving cells’ survival and function in the target tissue. Melatonin(MT) hormone with antioxidant properties can prolong cell survival and improve cell function. This study investigates the pre-conditioning of ADSCs with melatonin for enhancing the engraftment and neurological function of rats undergoing SCI.

Methods

42 male Sprague–Dawley rats were divided into six groups, including Control, Sham, Model, Vehicle, and Lesion treatments A and B. After acquiring white adipose tissue, stem cells were evaluated by flow cytometry. SCI was then applied in Model, Vehicle, A, and B groups. Group A and B received ADSCs and ADSCs + melatonin, respectively, 1 week after SCI, but the vehicle received only an intravenous injection for simulation; The other groups were recruited for the behavioral test. Immunohistochemistry(IHC) was used to assess the engraftment and differentiation of ADSCs in the SCI site. Basso, Beattie, and Bresnahan's score was used to evaluate motor function between the six groups.

Results

Histological studies and cell count confirmed ADSCs implantation at the injury site, which was higher in the MT-ADSCs (P < 0.001). IHC revealed the differentiation of ADSCs and MT-ADSCs into neurons, astrocytes, and oligodendrocyte lineage cells, which were higher in MT-ADSCs. Functional improvement was observed in SCI + ADSCs and SCI + MT-ADSCs groups.

Conclusion

The pre-conditioning of ADSCs with melatonin positively affects engraftment and neuronal differentiation in SCI but does not impact performance improvement compared to the ADSCs.

Bibliometric analysis of research on gene expression in spinal cord injury

Background

Spinal cord injury (SCI) is a severe disease with motor and sensory function being destroyed, which leads to a poor prognosis and a serious financial burden. It is urgent to figure out the molecular and pathological mechanisms of SCI to develop feasible therapeutic strategies. This article aims to review documents focused on gene expression in SCI and summarize research hotspots and the development process in this field.

Methods

Publications of SCI-related studies from 2000 to 2022 were retrieved from the Web of Science Core Collection database. Biblioshiny was used to evaluate the research performance, core authors, journals and contributed countries, together with trend topics, hotspots in the field, and keyword co-occurrence analysis. Visualized images were obtained to help comprehension.

Results

Among 351 documents, it was found that the number of annual publications increased in general. The most productive country was China, followed by the United States with the highest influence and the most international cooperation. Plos One was the journal of the maximum publications, while Journal of Neuroscience was the most influential one. According to keyword co-occurrence and trend topics analysis, these articles mainly focused on molecular and pathological mechanisms as well as novel therapies for SCI. Neuropathic pain, axonal regeneration and messenger RNA are significant and promising research areas.

Conclusion

As the first bibliometric study focused on gene expression in SCI, we demonstrated the evolution of the field and provided future research directions like mechanisms and treatments of SCI with great innovativeness and clinical value. Further studies are recommended to develop more viable therapeutic methods for SCI.

The roles and applications of neural stem cells in spinal cord injury repair

Spinal cord injury (SCI), which has no current cure, places a severe burden on patients. Stem cell-based therapies are considered promising in attempts to repair injured spinal cords; such options include neural stem cells (NSCs). NSCs are multipotent stem cells that differentiate into neuronal and neuroglial lineages. This feature makes NSCs suitable candidates for regenerating injured spinal cords. Many studies have revealed the therapeutic potential of NSCs. In this review, we discuss from an integrated view how NSCs can help SCI repair. We will discuss the sources and therapeutic potential of NSCs, as well as representative pre-clinical studies and clinical trials of NSC-based therapies for SCI repair.

Mechanical analysis of deep tissue injury during sitting in patients with spinal cord injury via parametric finite element model

Spinal cord injury patients are prone to develop deep tissue injury because of long-term mechanical load. However, there is a lack of statistical research on the influence of tissue characteristics on the internal mechanical state of soft tissue. This study aimed to investigate the influence of tissue characteristics on the internal mechanical state of buttock in spinal cord injury patients. A three-dimensional reference buttock model was established and a visualization program was generated to modify the parameter values. Through changing the muscle atrophy, body mass index and the radius of curvature of the ischial tuberosity, 96 different model variants were simulated and validated in this study. With body mass index increasing from 16 to 40, the principal shear stress was 10.4 times principal compressive stress, the maximum shear strain and the max cluster volume increased by 1.2 (P < 0.001) and 8.8 times (P < 0.001), respectively. The interaction between BMI and muscle atrophy was significant when BMI was greater than or equal to 22.5 kg/m². In all BMI stages, when the radius of curvature of the ischial tuberosity was 19 mm, the internal stress of the tissue always occupies the highest value. The results demonstrate that body mass index is the most important factor affecting the risk of buttock deep tissue injury. This study provides insights into investigation of inter-individual factors influencing the soft tissue response and assessment of deep tissue injury risk during sitting.

Epidemiology of spinal cord injury in China: A systematic review of the chinese and english literature

STUDY DESIGN

Systematic review.

OBJECTIVES

We aimed to provide a comprehensive overview of the English and Chinese literature reporting epidemiological data on spinal cord injury (SCI) in China.

METHODS

3 English and 3 Chinese language electronic databases were searched from the earliest record to 15 March 2020. Sociodemographic characteristics, incidence rates, etiology and lesion characteristics, in-hospital mortality, and secondary health conditions and complications were extracted from included reports.

RESULTS

A total of 51 studies were included, 32 in the Chinese language. Forty-seven studies were based on hospital records. Mean age of incident cases ranged from 34 to 55 years and male-to-female ratios ranged from 0.35:1 to 15.3:1. SCI incidence varied from 14.6 to 60.6 per million. Thirty-five studies reported only on traumatic SCI with traffic accidents, high falls, low falls and being hit by objects being the most common causes. Specific causes for non-traumatic SCI were poorly reported. Proportions with tetraplegia and complete injury ranged from 37.4% to 82.0% and 14.1% to 73.9%, respectively. Reported in-hospital mortality attributed to SCI varied from 1.1% to 18.4%. Leading cause of in-hospital mortality for acute SCI was respiratory problems; respiratory problems, urinary tract infections and pressure sores were the most common complications.

CONCLUSION

Epidemiological data on SCI in China are only available for a limited number of provinces and mostly outdated. Updated data on incidence with accurate geographical information and etiology across all Chinese provinces are needed for targeted implementation of preventive strategies. Research on community outcomes needs to be developed in China.

Upper Cervical Spine Injuries: Profile and Management of 120 Cases

OBJECTIVES

To identify the profile and management of patients with upper cervical spine injury.

METHODS

Retrospective cohort study of patients with upper cervical spine injuries managed at Hospital da Restauração between 2014 and 2020.

RESULTS

It presents the profile of 145 injuries recorded by location and classification among the 120 patients, and the management performed. Men are more affected than women, almost half of the patients (42.5%) were aged 16 to 29 years. Neurological deficit was present in 18 cases (15%). Twenty cases presented injury involving the level C1. Most injuries (109 [90.8%]) occurred at the C2 level, the most frequent of which were as follows: isolated type II odontoid fracture (29.2%), miscellaneous fracture of C2 (20%), and isolated hangman's fracture (13.3%). The most used management in type II odontoid fracture was C1-C2 posterior arthrodesis (17/42) followed by odontoid osteosynthesis (12/42). Regarding isolated hangman's fracture, conservative management was performed in 37.5% (6/16), and the technical approach most performed was anterior C2-C3 discectomy and interbody fusion (5/16).

CONCLUSIONS

Upper cervical spine injury has a higher prevalence in young men and is most often caused by traffic accidents. The main level affected is C2, and type II odontoid fracture is the most frequent subtype. C1 injury is related to conservative treatment, while C2 or combined C1-C2 injury is related to surgical approach. The management of these injuries is mainly performed with surgical treatment, with C1-C2 posterior arthrodesis and anterior odontoid osteosynthesis representing most of the approaches.

Nogo-A Is a Potential Prognostic Marker for Spinal Cord Injury

Objective

Spinal cord injury (SCI) has become prevalent worldwide in recent years, and its prognosis is poor and the pathological mechanism has not been fully elucidated. Nogo-A is one of the isoforms of the neurite outgrowth inhibitory protein reticulon 4. The purpose of this study was to determine whether Nogo-A could be used as a marker for predicting the prognosis of SCI.

Methods

We screened eligible SCI patients and controls based on inclusion and exclusion criteria. We also collected baseline clinical information and peripheral venous blood of the enrolled population. Participants' baseline serum Nogo-A levels were measured by enzyme-linked immunosorbent assay (ELISA). The American Spinal Injury Association (ASIA) scale was used to evaluate the prognosis of SCI patients after 3 months.

Results

Baseline clinical information (age; gender; smoking; drinking; SBP, systolic blood pressure; DBP, diastolic blood pressure; fasting blood glucose; WBC, white blood cells; CRP, C-reactive protein) of SCI patients and controls were not statistically significant academic differences (p > 0.05). The baseline serum Nogo-A levels of SCI patients and controls were 192.7 ± 13.9 ng/ml and 263.1 ± 22.4 ng/ml, respectively, and there was a statistically significant difference between the two groups (p < 0.05). We divided SCI patients into 4 groups according to their baseline serum Nogo-A quartile levels and analyzed their relationship with ASIA scores. The trend test results showed that with the increase of Nogo-A level, the ASIA sensation score and ASIA motor score were significantly decreased (p < 0.001). Multivariate regression analysis showed that serum Nogo-A levels remained a potential cause affecting the prognosis of SCI after adjusting for confounding factors in multiple models.

Conclusions

Serum Nogo-A levels were significantly elevated in SCI patients. Moreover, elevated Nogo-A levels often indicate poor prognosis and can be used as a marker to predict the prognosis of SCI.

Genistein Protects against Spinal Cord Injury in Mice by Inhibiting Neuroinflammation via TLR4-Mediated Microglial Polarization

Objective

The present study was designed to study the effect of genistein on spinal cord injury (SCI) in mice and to explore its underlying mechanisms.

Methods

We established SCI mouse model, and genistein was administered for treatment. We used the Basso, Beattie, and Bresnahan (BBB) exercise rating scale to evaluate exercise recovery, and the detection of spinal cord edema was done using the wet/dry weight method. Apoptosis was determined by TUNEL staining, and inflammation was evaluated by measuring inflammatory factors by an ELISA kit. The expression of M1 and M2 macrophage markers was determined using flow cytometry, and the expression of proteins was detected using immunoblotting.

Results

Genistein treatment not only improved the BBB score but also reduced spinal cord edema in SCI mice. Genistein treatment reduced apoptosis by increasing Bcl2 protein expression and decreasing Bax and caspase 3 protein expression. It also reduced the expression of inflammatory cytokines (TNF-α, IL-1β, IL-6, and IL-8) in the SCI area of SCI mice. Flow cytometry analysis indicated that genistein treatment significantly decreased the ratio of M1 macrophages (CD45+/Gr-1-/CD11b+/iNOS+) and increased the ratio of M2 macrophages (CD45+/Gr-1-/CD11b+/Arginase 1+) in the SCI area of SCI mice on the 28th day after being treated with genistein. We also found that genistein treatment significantly decreased the expression of TLR4, MyD88, and TRAF6 protein in the SCI area of SCI mice on 28th day after being treated with genistein.

Conclusion

Our findings suggested that genistein exerted neuroprotective action by inhibiting neuroinflammation by promoting the activation of M2 macrophages, and its underlying mechanisms might be related to the inhibition of the TLR4-mediated MyD88-dependent signaling pathway.

Strategies for effective neural circuit reconstruction after spinal cord injury: use of stem cells and biomaterials

Spinal cord injury (SCI), a serious disease of the central nervous system, often with irreversible loss of motor or sensory functions. Failure of axon connection and inhibition of microenvironment after SCI severely hinder the regeneration of damaged tissue and neuron function. Therefore, the new perspective of treatment of spinal cord injury is the reconstruction of neural circuit. Stem cells are a kind of cells with differentiation potential. They reconstruct local circulation by differentiating into neurons to replace damaged cells. It can also secrete various factors to regulate the host microenvironment and play a therapeutic role. Biomaterials can fill the cavity at the site of spinal cord injury, load therapeutic drugs, provide adsorption sites for transplanted cells and play a bridging role. In this review, the therapeutic role of stem cells and biomaterials is discussed, together with their properties, advantages, limitations, and future perspectives, providing a reference for basic and clinical research on SCI treatment.

Circular Ribonucleic Acid Expression Alteration in the Spinal Cord Tissue after Spinal Cord Injury in Rats

BACKGROUND AND PURPOSE

Increased researches focus into pathophysiological mechanisms of spinal cord injury (SCI), particularly toward the relationship between relevant biomarkers and the degree of SCI and prognosis. Circular ribonucleic acids (circRNAs) possess microRNA (miRNA) binding sites that can play the role of miRNA sponges and thus participate in the expression of parental gene modification. This study focused on rat SCI models and explore the relationship between circRNAs and SCI at a genomic level.

METHODS

We first established a rat SCI model and extracted the target spinal cord tissue according to 4 time points. Then investigated the alterations in the circRNA expression by high-throughput whole transcriptome sequencing, analyzed data by gene ontology and the Kyoto Encyclopedia of Genes and Genomes, and constructed the circRNA-miRNA network.

RESULTS

A total of 178 circRNAs were dysregulated (89 upregulated/89 downregulated). Differential circRNAs were found to be mainly involved in the composition of specific organelles in the cytoplasm and are mainly involved in the energy transfer process associated with electron transfer (and similar activities). In all the signaling pathways identified in this study, the MAPK, Wnt, and mTOR signaling pathways are intimately associated with the pathophysiological process of rats post-SCI. In this study, 10 circRNAs with obvious dysregulation were selected for prediction, 26 miRNAs with additional interactions were obtained, and a network diagram of circRNAs-miRNAs was constructed. In this manner, one can understand in further detail the pathogenesis of SCI and to provide new strategies for the prevention, diagnosis, and treatment of SCI-related injuries at the genetic level.

Electroacupuncture in promoting neural repair after spinal cord injury: Inhibiting the Notch signaling pathway and regulating downstream proteins expression

Spinal cord injury (SCI) is one of the serious central nervous system injuries and the incidence of SCI continues to increase. Previous studies have indicated that electroacupuncture (EA) is beneficial for promoting recovery after SCI. In the present study, we attempted to evaluate how EA can promote the neural repair in SCI model rats by observing changes in the Notch signaling pathway. Experimental rats were randomly divided into four groups. Each group had its own intervention period: 1 day, 7 days, 14 days, and 28 days, and five randomized subgroups: blank control (B) group, blank electroacupuncture (BE) group, sham operation (S) group, model control (M) group and EA group. Animals in the EA group and the BE group were treated with EA at Dazhui (GV14) and Mingmen (GV4) acupoints for 20 min. After the intervention period, the Basso-Beattie-Bresnahan (BBB) score was used to evaluate the neurological function. We found that BBB score increased in EA-treated groups. Hematoxylin and eosin staining was used to observe pathological changes in the injured spinal cord and the results showed that EA therapy could promote the repair of injured spinal cord tissue. Immunohistochemistry and Western blot methods were used to detect the expression of proteins Delta1, Presenilin1, Hes1, and Hes5 in the injured spinal cord. The results showed that the expression levels of Delta1, Presenilin1, Hes1, and Hes5 increased significantly after SCI and decreased after EA treatment. Our study suggested that the possible mechanism by which EA could benefit the recovery after SCI in rats may include inhibiting the Notch signaling pathway and regulating the downstream proteins expression. In addition, our study can provide reference for selecting acupoints and treatment cycle in the treatment of SCI.

Trends of epidemiological characteristics of traumatic spinal cord injury in China, 2009-2018

OBJECTIVE

We focus on providing the first comprehensive national dataset on the incidence, injury aetiology and mortality of TSCI in China.

METHODS

A multi-stage stratified cluster sampling method was used. We included TSCI cases from all hospitals in three regions, nine provinces and 27 cities in China via search of electronic medical records and retrospectively analysed the characteristics of TSCI in China from 2009 to 2018. We estimated the incidence of TSCI in the total population and subgroups.

RESULTS

There were 5954 actual cases in 2009, corresponding to a total estimated TSCI incidence of 45.1 cases per million population (95% CI, 44.0-46.3). There were 10,074 actual cases in 2018, corresponding to a total estimated TSCI incidence of 66.5 cases per million population (95% CI, 65.2-67.8) (P < 0.001; annual average percentage change (AAPC), 4.4%). From 2009 to 2018, the incidence of almost all sex/age groups showed an increasing trend over time (P < 0.001; AAPC, 0.7-8.8%). The elderly population (aged 65-74) displayed the highest incidence of TSCI (with an average annual incidence of 127.1 cases per million [95% CI, 119.8-134.3]).

CONCLUSIONS

The TSCI incidence increased significantly from 2009 to 2018. The incidence in the elderly populations was consistently high and continues to increase over time. The mortality of TSCI patients in hospitals is relatively low and continues to decrease each year, but elderly individuals remain at a high risk of hospital death.

The Prognostic Value of Leucine-Rich α2 Glycoprotein 1 in Pediatric Spinal Cord Injury

Objective

Leucine-rich α2 glycoprotein 1 (LRG1) is a novel cytokine, which is believed to be involved in the inflammatory process of a series of diseases. However, the relationship between LRG1 and spinal cord injury (SCI) has not been reported. The purpose of our study is to determine the predictive value of LRG1 for the prognosis of pediatric SCI (PSCI).

Methods

This study recruited 64 patients with confirmed PSCI and 40 healthy controls at Foshan Traditional Chinese Medicine Hospital from January 2016 to December 2020. The clinical information of all participants at the time of admission was recorded. Peripheral blood was collected, and commercial reagents were used to detect the level of serum LRG1. At the same time, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) was used to assess the severity of PSCI.

Results

All participants were divided into PSCI group (n = 64) and NC group (n = 40). There was no significant difference in clinical information (age, gender, heart rate, systolic blood pressure, diastolic blood pressure, sampling time from injury, white blood cells, and C-reactive protein) between the two groups (p > 0.05). According to the interquartile range of serum LRG1, we compared the motor and sensory scores of ISNCSCI and found that serum LRG1 levels were negatively correlated with the prognosis of PSCI patients (p < 0.001). The results of receiver operating curve (ROC) showed that the sensitivity, specificity, and AUC (Area Under the Curve) of serum LRG1 level in predicting the prognosis of PSCI were 68.4%, 69.1%, and 0.705, respectively. The cut-off value of serum LRG1 level predicting the prognosis of PSCI is 21.1 μg/ml.

Conclusions

Serum LRG1 level is significantly increased in PSCI patients, and the elevated LRG1 level is negatively correlated with the prognosis of PSCI patients. Serum LRG1 may be a potentially useful biomarker for predicting PSCI.

Relationship Between Level of Economic Development, Age, and Etiology of Spinal Cord Injury: A Cross-Sectional Survey From 22 Countries

OBJECTIVE

To examine relationships between age and spinal cord injury (SCI) and cause of SCI and how this depends on economic development.

DESIGN

Cross-sectional survey.

SETTING

Community, 22 countries representing all stages of economic development.

PARTICIPANTS

A total of 12,591 adults with SCI (N=12,591).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Interactions between age at injury and gross domestic product per capita based on purchasing power parity (GDP PPP) quartiles calculated with the application of logistic regression with the Maximum Likelihood estimator. Independence between SCI cause and age was assessed with the Wald test.

RESULTS

In persons with traumatic SCI, younger age was associated with a higher likelihood of injury in motor vehicle collisions, whereas older individuals had a greater chance of SCI due to falls. Associations between increased likelihood of high-energy traumatic SCI and younger age, low-energy traumatic SCI with older age, nontraumatic SCI with older age in persons injured in adulthood, and a higher prevalence of incomplete SCI lesions in individuals injured at an older age were revealed. Higher GDP PPP influenced positively the likelihood of low-energy SCI in older individuals and was negatively associated with the chance of sustaining SCI in motor vehicle collisions and the likelihood of having nontraumatic SCI at an older age.

CONCLUSIONS

SCI in older age is predominantly because of falls and nontraumatic injuries. Higher country income is associated with an increased proportion of SCI sustained later in life because of low-energy trauma involving cervical injury and a lower chance of being because of motor vehicle collisions. An increased prevalence of nontraumatic SCI in older individuals associated with lower country income may reflect a higher exposure to socially preventable conditions and lower access to or efficacy of health care. Future studies on etiology of SCI should make the distinction between low and high falls and overcome underrepresentation of older persons.

Potential medicinal value of celastrol and its synthesized analogues for central nervous system diseases

The central nervous system (CNS) is a vital part of the human nervous system, and the incidence of CNS disease is increasing year by year, which has become a major public health problem and a prominent social problem. At present, the drugs most commonly used in the clinic are receptor regulators, and neurotransmitter inhibitors, but they are accompanied by serious side effects. Therefore, the identification of new drugs and treatment strategies for CNS disease has been a research hotspot in the medical field. Celastrol, a highly bio-active pentacyclic triterpenoid isolated from Tripterygium wilfordii Hook. F, has been proved to have a wide range of pharmacological effects, such as anti-inflammation, immunosuppression, anti-obesity and anti-tumor activity. However, due to its poor water solubility, low bioavailability and toxicity, the clinical development and trials of celastrol have been postponed. However, in recent years, the extensive medical value of celastrol in the treatment of CNS diseases such as nervous system tumors, Alzheimer's disease, Parkinson's disease, cerebral ischemia, multiple sclerosis, spinal cord injury, and amyotrophic lateral sclerosis has gradually attracted intensive attention worldwide. In particular, celastrol has non-negligible anti-tumor efficacy, and as there are no 100% effective anti-tumor drugs, the study of its structural modification to obtain better leading compounds with higher efficiency and lower toxicity has aroused strong interest in pharmaceutical chemists. In this review, research progress on celastrol in CNS diseases and the synthesis of celastrol-type triterpenoid analogues and their application evaluation in disease models, such as CNS diseases and autotoxicity-related target organ cancers in the past decade are summarized in detail, in order to provide reference for future better application in the treatment of CNS diseases.

Traumatic spinal cord injury caused by low falls and high falls: a comparative study

BACKGROUND

Quite a few traumatic spinal cord injuries (TSCI) were caused by falls. However, the comparison of different causes of TSCI or the epidemiological characteristics of TSCI caused by falls of different heights are rare. This study investigated the epidemiological characteristics of TSCI caused by falls and conducted a comparison between low falls and high falls.

METHOD

Data from cases with TSCI admitted to China Rehabilitation Research Center from 2010 to 2019 were collected, including age, gender, occupation, cause, neurological level, and severity of the injury in admission, combined injuries, complications, and rehabilitation length of stay. Mann-Whitney U and chi-square (χ2) tests were used to assess the differences between two groups at a statistical significance level of 0.05.

RESULT

A total of 1858 TSCI cases were included and 41.7% were caused by falls, 11.4% by low falls and 30.3% by high falls, respectively. Patients with fall-induced TSCI were older and had a shorter rehabilitation length of stay than those with non-fall-induced TSCI. Patients with high fall-induced TSCI were younger and more likely to suffer from paraplegia, severer injuries, and combined injuries, and had longer time from injury to rehabilitation and rehabilitation length of stay, compared with patients with low fall-induced TSCI.

CONCLUSION

Falls is the leading causes of TSCI and high fall is becoming more common. Attention not only should be paid to high falls for the severe injury and longer hospitalization, but also low falls due to the higher neurological level of the injury and the aging of population in China.

Role of pyroptosis in spinal cord injury and its therapeutic implications

BACKGROUND

Currently, spinal cord injury (SCI) is a pathological incident that triggers several neuropathological conditions, leading to the initiation of neuronal damage with several pro-inflammatory mediators' release. However, pyroptosis is recognized as a new programmed cell death mechanism regulated by the stimulation of caspase-1 and/or caspase-11/-4/-5 signaling pathways with a series of inflammatory responses.

AIM

Our current review concisely summarizes the potential role of pyroptosis-regulated programmed cell death in SCI, according to several molecular and pathophysiological mechanisms. This review also highlights the targeting of pyroptosis signaling pathways and inflammasome components and its therapeutic implications for the treatment of SCI.

KEY SCIENTIFIC CONCEPTS

Multiple pieces of evidence have illustrated that pyroptosis plays significant roles in cell swelling, plasma membrane lysis, chromatin fragmentation and intracellular pro-inflammatory factors including IL-18 and IL-1β release. In addition, pyroptosis is directly mediated by the recently discovered family of pore-forming protein known as GSDMD. Current investigations have documented that pyroptosis-regulated cell death plays a critical role in the pathogenesis of multiple neurological disorders as well as SCI. Our narrative article suggests that inhibiting the pyroptosis-regulated cell death and inflammasome components could be a promising therapeutic approach for the treatment of SCI in the near future.

Local delivery of USC-derived exosomes harboring ANGPTL3 enhances spinal cord functional recovery after injury by promoting angiogenesis

Background

Spinal cord injury is a devastating clinical condition for which there are currently no effective therapeutic options. In the present study, we aim to investigate if the effect of an administered injection of exosomes derived from human urine stem cell (USC-Exo) embedded in hydrogel could improve the spinal cord functional recovery after injury and the underlying mechanism.

Methods

Exosomes were isolated from USC and identified by transmission electron microscopy (TEM) and Western blot. Functional assays in vitro were performed to assess the effects of USC-Exo on tube formation and migration, as well as their regulatory role in the PI3K/AKT signaling pathway activation. A locally administered injection of exosome embedded in hydrogel was used for SCI treatment. The effects of USC-Exo on functional recovery and the role of the candidate protein ANGPTL3 harboring in USC-Exo for promoting angiogenesis in SCI model were assessed.

Results

In the current study, we demonstrate that a locally administered injection of USC-Exo embedded in hydrogel can pass the spinal cord blood-brain barrier and deliver ANGPTL3 to the injured spinal cord region. In addition, the administration of human USC-Exo could enhance spinal cord neurological functional recovery by promoting angiogenesis. The results of mechanistic studies revealed that ANGPTL3 is enriched in USC-Exo and is required for their ability to promote angiogenesis. Functional studies further confirmed that the effects of USC-Exo on angiogenesis are mediated by the PI3K/AKT signaling pathway.

Conclusion

Collectively, our results indicate that USC-Exo serve as a crucial regulator of angiogenesis by delivering ANGPTL3 and may represent a promising novel therapeutic agent for SCI repair.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13287-020-02078-8.

Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version)

Treatment of spinal cord injury (SCI) remains challenging. Considering the rapid developments in neurorestorative therapies for SCI, we have revised and updated the Clinical Therapeutic Guidelines for Neurorestoration in Spinal Cord Injury (2016 Chinese version) of the Chinese Association of Neurorestoratology (Preparatory) and China Committee of International Association of Neurorestoratology. Treatment of SCI is a systematic multimodal process that aims to improve survival and restore neurological function. These guidelines cover real-world comprehensive neurorestorative management of acute, subacute, and chronic SCI and include assessment and diagnosis, pre-hospital first aid, treatment, rehabilitation, and complication management.

Serum CCL21 as a Potential Biomarker for Cognitive Impairment in Spinal Cord Injury

Objective

Cognitive impairment is considered to be an important complication of spinal cord injury (SCI), but its underlying mechanism remains unclear. The purpose of this study is to explore whether serum CCL21 can be used as a potential biomarker of cognitive impairment in SCI.

Methods

In Neck-Shoulder and Lumbocrural Pain Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, hospitalized or treated acute SCI patients were included in the study as the SCI group (SCI). At the same time, a normal control group (NC) matching the age and sex of the SCI group was recruited in the outpatient clinic. Once the two groups were enrolled, their demographics and clinical characteristics were collected immediately. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum CCL21 levels within 24 hours of admission. Three months later, the Montreal Cognitive Assessment (MoCA) was used to test the cognitive function of the population.

Results

A total of 84 SCI patients and 49 NC populations were eligible for inclusion in the study. There was no significant statistical difference in the demographics and clinical characteristics (age, gender, BMI, TG, LDL-C, FBG, SBP, and DBP) between the two groups (p > 0.05). Compared with the NC group, the SCI group had a higher serum CCL21 level (p < 0.001) and a lower MoCA score (p < 0.001). Serum CCL21 level in SCI was negatively correlated with MoCA score (p = 0.023). Multivariable analyses showed that serum CCL21 level is an independent prognostic factor of cognitive impairment in SCI.

Conclusions

MoCA score has a linear relationship with serum CCL21 quartile, and SCI cognitive function has a negative correlation with serum CCL21. Serum CCL21 is an independent risk factor for cognitive impairment after SCI.

Advances in immunotherapy for the treatment of spinal cord injury

Spinal cord injury (SCI) is a leading cause of morbidity and disability in the world. Over the past few decades, the exact molecular mechanisms describing secondary, persistent injuries, as well as primary and transient injuries, have attracted massive attention to the clinicians and researchers. Recent investigations have distinctly shown the critical roles of innate and adaptive immune responses in regulating sterile neuroinflammation and functional outcomes after SCI. In past years, some promising advances in immunotherapeutic options have efficaciously been identified for the treatment of SCI. In our narrative review, we have mainly focused on the new therapeutic strategies such as the maturation and apoptosis of immune cells by several agents, mesenchymal stem cells (MSCs) as well as multi-factor combination therapy, which have recently provided novel ideas and prospects for the future treatment of SCI. This article also illustrates the latest progress in clarifying the potential roles of innate and adaptive immune responses in SCI, the progression and specification of prospective immunotherapy and outstanding issues in the area.

The changing demographics of traumatic spinal cord injury in Beijing, China: a single-centre report of 2448 cases over 7 years

STUDY DESIGN

Retrospective study.

OBJECTIVES

To investigate the epidemiological changes in persons with traumatic spinal cord injury (TSCI) over the past 7 years in Beijing Bo'ai Hospital, China Rehabilitation Research Center, China.

SETTING

Beijing Bo'ai Hospital, China Rehabilitation Research Center (CRRC).

METHODS

A database containing the records of all persons treated with SCI from 1 January 2013 to 31 December 2019 was reviewed. Variables including demographic and clinical data were analysed. Comparisons were made with data previously published in 2002.

RESULTS

During the study period, 2448 persons with recent TSCI were included in the analysis. The mean age at the time of injury increased from 38.1 years to 40.2 years (P = 0.025). The percentage of elderly persons increased (8.8-14.6%, P = 0.036) and was higher than that in 2002. The percentage of retirees increased. Transport related injuries were the leading cause of injury and the percentage of TSCI due to low falls increased 6%. Low falls were the most common cause for elderly persons (y ≥ 60) and were even higher for elderly women. Persons with cervical injuries increased compared to the 2002-data (44.1% vs 4.9%). The percentage of persons with incomplete SCI increased significantly over the study duration.

CONCLUSIONS

Persons with TSCI are becoming older, and the percentage of elderly persons is increasing year by year. These changes are likely due to a combination of population ageing in the region and changes in aetiology, with corresponding changes including an increase in persons with cervical TSCI and persons with incomplete injury.

Epidemiological characteristics of spinal cord injury in Northwest China: a single hospital-based study

Background

While the cities in China in which spinal cord injury (SCI) studies have been conducted previously are at the forefront of medical care, northwest China is relatively underdeveloped economically, and the epidemiological characteristics of SCI have rarely been reported in this region.

Methods

The SCI epidemiological survey software developed was used to analyze the data of patients treated with SCI from 2014 to 2018. The sociodemographic characteristics of patients, including name, age, sex, and occupation, were recorded. The following medical record data, obtained from physical and radiographic examinations, were included in the study: data on the cause of injury, fracture location, associated injuries, and level of injury. Neurological function was evaluated using the American Spinal Injury Association (ASIA) impairment scale. In addition, the treatment and complications during hospitalization were documented.

Results

A total of 3487 patients with SCI with a mean age of 39.5 ± 11.2 years were identified in this study, and the male to female ratio was 2.57:1. The primary cause of SCI was falls (low falls 47.75%, high falls 37.31%), followed by traffic accidents (8.98%), and impact with falling objects (4.39%). Of all patients, 1786 patients (51.22%) had complications and other injuries. According to the ASIA impairment scale, the numbers of grade A, B, C, and D injuries were 747 (21.42%), 688 (19.73%), 618 (17.72%), and 1434 (41.12%), respectively. During the hospitalization period, a total of 1341 patients experienced complications, with a percentage of 38.46%. Among all complications, pulmonary infection was the most common (437, 32.59%), followed by hyponatremia (326, 24.31%), bedsores (219, 16.33%), urinary tract infection (168, 12.53%), deep venous thrombosis (157, 11.71%), and others (34, 2.53%). Notably, among 3487 patients with SCI, only 528 patients (15.14%) received long-term rehabilitation treatment.

Conclusion

The incidence of SCI in northwest China was on the rise with higher proportion in males; fall and the MCVs were the primary causes of SCI. The occupations most threatened by SCI are farmers and workers. The investigation and analysis of the epidemiological characteristics of SCI in respiratory complications are important factors leading to death after SCI, especially when the SCI occurs in the cervical spinal cord. Finally, the significance of SCI rehabilitation should be addressed.

Strategies and prospects of effective neural circuits reconstruction after spinal cord injury

Due to the disconnection of surviving neural elements after spinal cord injury (SCI), such patients had to suffer irreversible loss of motor or sensory function, and thereafter enormous economic and emotional burdens were brought to society and family. Despite many strategies being dealing with SCI, there is still no effective regenerative therapy. To date, significant progress has been made in studies of SCI repair strategies, including gene regulation of neural regeneration, cell or cell-derived exosomes and growth factors transplantation, repair of biomaterials, and neural signal stimulation. The pathophysiology of SCI is complex and multifaceted, and its mechanisms and processes are incompletely understood. Thus, combinatorial therapies have been demonstrated to be more effective, and lead to better neural circuits reconstruction and functional recovery. Combinations of biomaterials, stem cells, growth factors, drugs, and exosomes have been widely developed. However, simply achieving axon regeneration will not spontaneously lead to meaningful functional recovery. Therefore, the formation and remodeling of functional neural circuits also depend on rehabilitation exercises, such as exercise training, electrical stimulation (ES) and Brain-Computer Interfaces (BCIs). In this review, we summarize the recent progress in biological and engineering strategies for reconstructing neural circuits and promoting functional recovery after SCI, and emphasize current challenges and future directions.

Neuroprotective Agents as an Adjuvant Treatment in Patients With Acute Spinal Cord Injuries: A Qualitative Systematic Review of Randomized Trials

STUDY DESIGN

This was a systematic literature review.

OBJECTIVE

The objective of this study was to evaluate randomized clinical trials that address potential neuroprotective agents used to improve neurological outcome in patients with spinal cord injury (SCI).

SUMMARY OF BACKGROUND DATA

Clinical treatment of acute SCI has evolved significantly, but neurological recovery of severely injured patients remains modest. Neuroprotective agents may act to limit secondary damage in the sequence of pathophysiologic insults that occur after primary SCI.

METHODS

We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines of all clinical randomized trials that evaluated potential neuroprotective agents (drugs, stem cells, and any type of medicative interventions) in neurological outcome of acute SCI. All the studies were graded according to their level of evidence in accordance with the Oxford Level of Evidence-based Medicine.

RESULTS

A total of 16 randomized clinical trials were included and fully analyzed in our review. The following 12 substances/drugs were analyzed: methylprednisolone (MP), naloxone, tirilizad, nimodipine, Sygen, autologous incubated macrophages, autologous bone marrow cells, minocycline, erythropoietin, ganglioside, vitamin D, and progesterone. Modest benefits were attributed to minocycline and Sygen (without statistical significance), and some benefits were obtained with erythropoietin and progesterone plus vitamin D in neurological outcome. For MP, the benefits are also controversial and may be attributed to statistical artifacts and with a high risk of adverse effects. The other substances did not change the final outcome. All studies were considered as grade B of recommendation (100%) and levels of evidences as B2 (81.25%) and B3 (18.75%).

CONCLUSIONS

Our review reported some potential substances that may improve neurological outcome in acute SCI: MP, vitamin D associated with progesterone, and erythropoietin. Their potential benefits were modest in the evaluated studies, requiring further randomized clinical trials with large samples of patients, without statistical artifacts, for routine clinical use. Furthermore, potential adverse effects must be considered with the use of neuroprotective agents in SCI. Until then, the use of these substances may be experimental or restricted to specific clinical situations.

Celastrol inhibits microglial pyroptosis and attenuates inflammatory reaction in acute spinal cord injury rats

Pyroptosis pathway is closely related to inflammation. However, Celastrol effect on pyroptosis pathway after spinal cord injury (SCI) are poorly understood. We studied the anti-inflammatory and neuroprotective effects of Celastrol on acute spinal cord injury in rats, and its anti-inflammatory effects on lipopolysaccharide (LPS)/ATP-induced microgliosis. Our results show that Celastrol can improve the recovery of hindlimb motor function after SCI in Sprague-Dawley (SD) rats, and reduce the cavity area of spinal cord injury along with the neuronal loss. Celastrol simultaneously reduced the activation of microglia (especially M1 microglia) in the spinal cord, inhibited the pyroptosis-related proteins (NLRP3 ASC Caspase-1 GSDMD), reduced the release of TNF-α IL-1β and IL-18 inflammatory factors, and increased the release of IL10 cytokines. In vitro studies showed that Celastrol reduced the toxicity resulting from the administration of LPS with ATP to BV-2 cells, inhibited the pyroptosis-related proteins (NLRP3 Caspase-1 GSDMD), and inhibited the release of corresponding inflammatory factors. Finally, Celastrol can inhibit the expression of NFκB/p-p65 in vitro and in vivo. Our results show that Celastrol can attenuate the inflammatory response of the spinal cord after SCI, which is associated with inhibition of microglial activation and pyroptosis pathway. Further study to explore the use of Celastrol to treat SCI is warranted.